What are the criteria for closing the regions

What are the criteria for placing an entire territory or region in the red zone, orange zone, or green zone? While the new Dpcm is waiting to be published in the Official Gazette and will come into force from tomorrow, November 5 to December 3, the report of the Istituto di Superiore di Sanità and the ministry that will divide Italy into three risk bands. . However, we already know that the indicators are at 21, from the occupancy of beds in the intensive care unit to the ability to monitor, from the spread of the virus to the speed of swabbing.

Red, orange, green zone: what are the criteria for closing regions?

The most important, explains Michele Bocci today in Repubblica, is the general risk rating, which ranges from high to moderate. Then there are the scenarios, which are based on the Rt contagion index and which have a level between 1 and 4 and which already classify five regions at risk of total blockage. The combination of these two indicators (high risk and scenario 4) leads to ending in the red zone. The assessment dates back to April 30, when the criteria were established at a time when the emergency appeared to be resolved. Meanwhile, the document “Prevention and response to Covid: evolution of the strategy and planning for the autumn-winter period” indicates what actions to take depending on the severity of the scenario.

Then there are six indicators on the ability to follow-up (the so-called follow-up of contacts, which in the meantime, according to experts, has been skipped); then there are 6 others, which describe “Ability to diagnose, investigate and manage contacts”. For example, the percentage of positive swabs excluding the second and third tests in the same people, or the time that passes from symptoms to quarantine and diagnosis. In high-risk areas that are framed in scenarios 3 and 4 indicated in the ISS document – those characterized by a ‘high severity scenario and those in which there are’ maximum severity situations – “any movement in and out of the territories “. The measure, which will be adopted by ordinance of the Minister of Health, may affect “entire regions or parts of them.” The difference between the areas that fall in scenario 3 and those that fall in scenario 4 is that in the latter, movements “within the same territories” are also prohibited, therefore, at the municipal and provincial level.

Then there are the indicators of results and related to the stability of transmission and the resilience of health services, which observe the growth or decrease in the number of positives in the last 7 and 14 days, the new outbreaks and for how many people the origin of infection. is unknown. The other criteria are the emergency situation, intensive care and medical services. The alarm bell rings when 30% of the seats dedicated to Covid-19 patients are occupied.

What’s in the new Dpcm

Stage 4 and the Rt

The four scenarios were included with the document “Prevention and response to Covid”, to give suggestions on the measures to take depending on the severity of the situation. They are based on RT, which is the replication factor of the disease for one week. These are, in summary, the four scenarios:

• SCENARIO 1: Localized transmission situation (outbreaks) substantially unchanged compared to the period July-August 2020, with regional Rt above the threshold for limited periods (less than 1 month) and low incidence, in the case that the transmissibility does not systematically increase at the beginning of the period. fall, schools have a modest impact on transmissibility and regional health systems can track and control new outbreaks, including school ones;
• SCENARIO 2: Sustained and generalized transmissibility situation but manageable by the health system in the short-medium term, with regional values ​​of Rt in a systematic and significant way between Rt = 1 and Rt = 1.25 (that is, with estimates of the interval of 95% confidence – 95% CI – of Rt between 1 and 1.25), in the event that new outbreaks, including schoolchildren, cannot be fully traced, but still largely limit the potential transmission of SARS-CoV-2 with ordinary and extraordinary containment / mitigation measures;
• SCENARIO 3: Sustained and generalized transmissibility situation with risks of maintaining the health system in the medium term, with regional values ​​of Rt in a systematic and significant way between Rt = 1.25 and Rt = 1.5 (that is, with estimates of IC 95% of Rt between 1, 25 and 1.5), and in which the transmission potential of SARS-CoV-2 can be limited only modestly with ordinary and extraordinary containment / mitigation measures. The increase in the number of cases could cause an overload of healthcare services in 2-3 months;
• SCENARIO 4: Uncontrolled transmissibility situation with criticality in the stability of the health system in the short term, with regional values ​​of Rt systematically and significantly higher than 1.5 (that is, with 95% CI estimates of Rt higher than 1.5). Although an epidemic of these characteristics would lead to more aggressive mitigation and containment measures in the affected territories, such a scenario could quickly generate a high number of cases and clear signs of overload of the healthcare services, without the possibility of tracking the situation. origin of new cases. The growth in the number of cases could lead to an overload of care services in 1-1.5 months, unless the epidemic spreads predominantly among the younger age groups, as observed in the period July-August 2020 , and managed to protect the most fragile categories (for example, the elderly). In this regard, it should be noted that it seems highly unlikely to be able to protect the most fragile categories in the presence of an epidemic characterized by these transmissibility values.

Based on this, the government has imagined that placing one region instead of another in the red, orange or green zone becomes automatic. And precisely about this the presidents of the Region have written a letter to Conte in which they express their concern about the passages of the Dpcm that “undermine the role and tasks of the Regions and autonomous Provinces, placing each election and decision in the government “and wants” a contradictory for the examination of the data “together with the technicians of the regional departments.

But beyond the governors’ attempts to launch him into politics, there are those who have serious scientific doubts about the main indicator, which is the Rt contagion index: ” The Rt index, the relationship between positives and swabs, and employment of hospitals are the parameters used by the whole world. But they have their limitations, ” he says. The Republic is Alessandro Vespignani, who teaches in Boston at Northeastern University and works on computer models for the spread of epidemics. ” From the beginning of the epidemic – he says – we have to deal with data that leaves something to be desired. But we realize that collecting them is a complex job and the situation is difficult for everyone. We know that these parameters reflect a situation dating back at least a week before. We can try to reduce this delay, but not eliminate it. ”

“The Rt index in Italy is well calculated – Vespignani concedes -. Then, of course, it reflects the delay between contagion and the notification of cases and does not always reach the territorial granularity that would be necessary. Because large cities are one thing, the rural areas an “other.” RT only counts symptoms, he explains, “for technical reasons: we need to indicate the date of onset of symptoms.” The problem with Rt is that it has very large margins of error. And if the results of the hyssop are late, it becomes a bad indicator. ” As for hospital occupancy rates, he continues, “in Italy they only take into account the balance of hospitalized patients. They do not calculate the number of those who enter and those who leave Instead, it would be important to know the flows, to understand the progress of the epidemic. The most difficult challenge with this virus is trying to predict its progress. If you find yourself chasing, everything becomes more difficult. “